My Interview with Chris Kresser on Unconventional Medicine

Hey everybody it's Dr. Mark Hyman. Welcome. I'm here with my good friend and one of my teachers, Chris Kresser, who's an extraordinary doctor, has done so much to advance the field of functional medicine and I'm just really excited to have him here. He's a leader in the field of ancestral health, paleo nutrition, functional medicine. He's created chrisKresser.com which is my go-to site for learning stuff that I want to know. One of the top 25 natural health sites in the world. And he's written your personal paleo code, which is a New York Times bestseller. And his recent book called unconventional medicine is really about this whole functional medicine movement and what we can do to really reverse this growing tide of chronic disease that's crippling our population with ill health and bankrupting our economy and just really a big problem, which is something that I obviously talk about a lot. So, Chris, I'm super excited about this book. I was at your book launch party last week in LA and we were bringing together all these great thought leaders in functional medicine and sharing some of the common experiences we've gone through and how we got here. So, maybe you could share with us today your background and what you went through that brought you into this world of alternative functional medicine. Sure.

Well, it's always a pleasure to be with you, Mark, so thanks for having me again. You know, like many people, including yourself, who came to functional medicine, and I came to it through my own experience of illness. In my case, I was traveling in Indonesia doing some surfing over there in my 20s. And I got the classic tropical illness, you know, vomiting, diarrhea, delirium. I was so sick, I don't even really remember much of the three days that that was happening. And I had a, you know, there was an Australian guy living in the village who had some antibiotics that helped kind of bring me back from the brink. That turned out to be only the beginning of a decade-long journey back to health that really, among other things, highlighted the insufficiency of conventional medicine for dealing with complex chronic illness. Now, all the doctors I saw met well, but it was just clear that they didn't have the tools to deal with the kind of challenges that I was facing.

Or the framework?

Or the framework or the paradigm or the understanding of it at all. And so they prescribed antibiotics for the infection and that helped a little bit. that in some cases, the treatment can be worse than the disease. Right. And that was definitely true in this case. And, and when it came time to help me actually navigate the complexities of diet and lifestyle and behavior change and, and, and doing the kind of more advanced testing to find other things that were going on, my doctors just by their own admission, you know, they weren't the right people to help with that. They didn't know what to do. They just throw up their hands and say, I'm sorry. I see how much you're suffering. I'd like to be able to help, but I, I I don't know what to do. And so that inspired me to do my own investigation and study and started to make progress and recover my health. And then eventually, you know, people around me started to ask, hey, what have you been doing? You know, I'd like to know more about that. And so it occurred to me over time that what I had learned in my own process of recovery could help other people. And that's when I went, decided to go back to school and pursue this as a career. And here I am.

That's amazing. All from a surfing trip.

Yeah, exactly. No, I mean, I was not, I didn't have the intention of becoming a practitioner. When I was a kid, and you asked me what I wanted to be when I grew up, but I don't know if I ever answered doctor. Maybe a surf bum. Yeah, pro surfer.

So, you talk about your own story, but you also share some amazing stories in your book. One of them is a kid called Leo, who really changed your whole view of healthcare and medicine. So, tell us about Leo and what happened and how this shifted your thinking.

Sure. Yeah. So, Leo was an eight-year-old when he came to see me and like so many kids these days, he had a number of behavioral issues. He was first diagnosed in the autism spectrum and then eventually they settled on OCD and sensory processing disorder. And, you know, oh, it was so hard for his parents. He would throw these just crazy tantrums. He was really particular about his environment. He had a super limited diet. He only ate a handful of foods, all of them processed and refined. And of course they took him to doctors and the doctors did what you would expect they would do. They prescribed medication that Leo would have to take indefinitely. And his parents weren't really even aware that there was something else that they could do. This was the thing that really struck me about Leo's experience. Like so many other parents, they weren't aware that it could be something in his diet or could another underlying issue like his gut or heavy metal toxicity or something like that could actually be causing his symptoms. But fortunately, one of his mom's friends had read a few articles on my blog on the gut-brain axis and the underlying causes of behavioral disorders in kids. And so they made an appointment to come see me and I did all my initial testing that you and I both do with all our new patients. And sure enough, he had disrupted gut microbiome, SIBO, fungal overgrowth, gluten intolerance, intolerance of corn and soy and buckwheat and rice and eggs, all these stuff that he was eating and his toaster waffles that he had for dinner every night. He had arsenic, high arsenic coming from the rice milk that he was drinking a lot of and a whole bunch of nutrient deficiencies because of his limited diet.

Which by the way are things that no doctors, regular doctors actually teach.

Absolutely, nobody, not one doctor, they saw primary care doctor, they saw psychiatrist.

We don't get trained on how to do that.

No, no. And so we addressed those issues which wasn't super easy because he had these OCD like tendencies, but over time made some huge progress, was throwing fewer tantrums, diet had expanded significantly, was able to function at school better, and really kind of became a different kid in about a nine-month period. And at the end of that time, his mom said something that really struck me, which was, why don't more doctors know about this? There are literally millions of kids out there like Leo that are suffering from these kinds of problems, and yet nobody's looking for the kind of things we've been talking about or addressing here. And that's really why I wrote the book, because I wanted to, I want people to know that there's an alternative to just suppressing symptoms with drugs, you know, both doctors and other practitioners and patients.

Yeah, so, yeah, so, you know, it's true that doctors don't really know about this. Why do you think that is?

Well, I mean, like you said, they're not really trained in that way. We have a paradigm, conventional medical paradigm that really evolved when acute infectious disease or other kinds of emergency trauma situations were the big the biggest challenge. Back in 1900, the top three causes of death were typhoid tuberculosis and pneumonia. All acute infectious diseases are the reason other people would see a doctor would be a broken bone or a gallbladder attack or an injury that they had at work. And, hey, conventional medicine is awesome for those kind of things, right? I mean, it's incredible what conventional medicine has accomplished in that way. Being able to reattach limbs and restore sight to the blind and If I get hit by a bus, I'm definitely going to the hospital. But those are all different challenges than what we're really facing today. Seven out of the top 10 causes of death are now chronic diseases like heart disease and lung disease and diabetes and obesity. And 86% of the healthcare dollars we spend go toward treating chronic disease. So I'm not saying we don't need standard conventional medicine. We still need to be able to remove cancerous tumors and do colonoscopies and endoscopies and take advantage of all these fantastic technologies, but we're using, that's not the tool for the job of dealing with chronic disease and chronic disease is the biggest challenge we face from a.

Healthcare perspective by far. So true, you know, it's so true. We just have this incredible epidemic and we're so ill equipped. I'm here at Cleveland Clinic today and we're, you know, working on how do we start to deal with this because this is an acute care hospital. It's got some of the highest acuity of any patients in the world. And yet they're also seeing this burden of chronic disease and they're not really sure what to do. And so we're actually working on a program to help build a chronic disease model into traditional care and actually doing it through groups and all sorts of approaches that really are very, very powerful. So I think it's really the future. So a lot of doctors, it's interesting when I got to Cleveland Clinic, some of the doctors were like, okay, whatever, this is nonsense, but that was very few. Some were like, what took you so long to get here? It's about time. And then the bulk were like, wow, this is interesting. I want to learn more. How do I learn more? So what advice would you give to people who are just kind of fed up and doctors who really want to do something different, but they're not trained, they don't know how? It's kind of overwhelming.

Yeah, I think the first thing is just learning about what the alternatives are and that there is another approach. That's where it starts for, you know, most many people who you've trained, Mark, and who follow your work and people that have followed my work. The first thing they need is a vision for the future, you know, not just their own future and what their life could look like and how their practice might change, but a vision of how healthcare could change in a way that would actually serve the needs that we face today.

Yeah, yeah, yeah.

Because I think if you don't have that, nothing else really matters. Or, you know, it's easy to become really jaded and cynical and burned out. And we know from the statistics that burnout is a growing problem. One in two doctors now feel, have ranked themselves as either often or always experiencing symptoms of burnout. We know that, you know, approximately 60, 70% of Physicians have thought of quitting medicine. You know, this is, this is terrible because most doctors go into this to help people, to really change people's lives and they're not feeling like they have that effect. So, I think the first thing is to actually get inspired about a different approach and actually reconnect with the original reasons that you went into medicine in the first place.

Yeah.

Because a lot of people have gotten out of touch with that.

I call it the reenchantment with medicine. You know, it happens when people come to functional medicine courses. Their programs are like, this is what I've always been wanting.

Exactly.

I had a doctor in my practice for the week who was shadowing me. She said, you know, she'd been to all these medical conferences looking at what to do. And when she got to the functional medicine training, she was like, this is exactly what I've been looking for. I just didn't know it existed. In fact, I had a phone call with me after a talk once at a conference, and she was literally crying. She was like, oh my God, I knew this is what existed. I knew this is what I wanted. I just didn't know it was possible. I didn't know that it was actually this happening in medicine right now. And it is, it's slow and there's a few of us doing it in the outskirts of medicine. But now at Cleveland Clinic, it's actually starting to get noticed and people are starting to be interested in other healthcare centers. And there's an awareness that our system is broken, that we are failing a chronic disease, that we need something new. that this makes sense. And people get inspired. We did a survey, it was kind of interesting, we did a survey of all the Cleveland Clinic staff, and we looked at how many and all the people who had been to programs who worked at Cleveland Clinic, we could track for the Institute for Functional Medicine. And we found that 10% of the Cleveland Clinic staff had gone to some functional medicine program, which was shocking to me. which means there's all these closet doctors out there who are kind of interested in this but don't really want to talk about it.

Yeah.

Do their job, but they don't know how to get out. So it's pretty exciting.

Yeah. Yeah. I mean that, and that's where programs like IFM, which has been the leader in this world for so many years, and my program, which is newer, come in because they can actually give people not only the over the overall framework and methodology of functional medicine and how it can be applied to prevent and reverse chronic disease, which is the most important thing that we need to be focusing on, not just managing it after it occurs, but also the clinical skills that they need. Because you and I both know, Mark, that it's a different thing. It's totally different thing to practice functional medicine than conventional medicine. Your whole practice will change, you know. everything from the amount of time that you spend with patients to the questions that you ask to the tests that you order to the treatments that you prescribe. It's a major overhaul.

Yeah, and then the good news is there is training available for those doctors who are interested in this Institute for Functional Medicine. Your ADAPT program makes it really practical. It's a great sort of translational approach that makes it really doable and specific and pretty extraordinary. So I'm just really grateful you created it. I think it's an awesome program.

Thank you. So.

We talked a little bit about chronic disease, talked about the fact that we now, for the first time in history, are having a generation that's going to live sicker and die younger than their parents. Why is that?

Well, this is one of the most heartbreaking statistics for me. I know you're a parent, Mark, and I am as well. I have a six-year-old daughter. And when I first read that statistic, my heart just broke. Lifespan has been steadily increasing since we started to measure it in the modern world. There's never been a generation that was expected to live shorter lifespans than their parents. We just take it for granted that our kids are going to live longer than us because it's always been that way for as long as we've been measuring it, but that's not the case now. And furthermore, as you pointed out, even if we are living longer than our ancestors or our more recent ancestors, like 100 years ago, the studies are showing that we're spending those last 10 or 20 years in a compromised state. We're burdened with chronic disease, we're immobile, we're spending a lot of that time in doctor's office, or a nursing home or some other situation where we're not actually enjoying an active, vibrant, healthy life at the end of those years. So what's happening is that we have failed, we've used modern technology and things like sanitation and antiseptic in the surgical theater and antibiotics and things like that to escape some of the challenges that our earlier ancestors faced in terms of not having access to emergency medical care, being dying from a cut that got infected. And so those things increased our lifespan to a certain point. But now, as I mentioned, chronic disease is what's killing us, not the cut that we get that gets infected or a surgeon using a knife that wasn't.

Properly- Slow death, right?

No, I call it a slow motion plague in my book, because I think it's every bit as insidious and dangerous as something like the bubonic plague, but it's just unfolding under a much longer timeframe.

It kills millions and millions and millions of more people.

Absolutely.

I read a statistic that chronic disease is a bigger killer than smoking, obesity for sure, and food-related diseases that are driving chronic disease. There's a bigger killer than smoking, all car accidents, alcohol. It's just the scale of it is enormous. If you actually think about how many people are suffering and how many people die and the causes really are our food system and the quality of the food and other things we eat. It's just mind-boggling that we're- Exactly. Yeah, I mean, if this many people were dying from, I don't know, car accidents, we'd be all up in arms and trying to figure it out and fix it, and yet no one is really fixing it.

Yeah, I so agree with that. I actually have said that I think this is, it's not an exaggeration to say that the survival of our species is at stake when we're talking about this stuff. And even in a relatively near future, the survival of the United States as a country, as a functioning financial entity is at stake. Because as we've both said, if we don't get a handle on healthcare expenditures, they're going to, at some point in most of our lifetimes of people that are listening to this and watching this, It will completely overtake the federal budget where we'll be spending 100% of our federal budget on healthcare with nothing left over for, you know, education, military, defense, anything. So this is a crisis at the level of like a national security emergency or even a threat, an existential threat to our species. And the Department of Defense has actually classified chronic disease as an existential threat equivalent to something like nuclear war or, you know, an attack on our soil because they recognize that that's what it is. We're not just talking about individual health here. We're talking about our ability to function as a as a nation and even as a as a species.

That's true. A friend of mine, Harvey Karp, who's on the board of the Environmental Working Group with me said, you know, that in this movie Fed Up, he said, you know, if a foreign nation was doing to our children what our own country and government are doing, we would go to war to protect them.

That's such a great point.

We would go to war to protect them because they are being polluted by the food industry, processed foods, sugar. I mean childhood obesity is, you know, it's just skyrocketing. Now one in four kids, teenagers, one in four are pre-diabetic or type two diabetic. I mean, it's astounding to me, one in four.

I mean, it's one thing when you see that for an adult, right? Because they're facing maybe 30 or 40 years of disability. What happens to an eight-year-old kid who's diagnosed with pre-diabetes? They're looking at decades of disability. And not only that, it's $14,000 a year to treat a patient with type 2 diabetes. What's that gonna do? I mean, it's crazy.

It is pretty crazy, Chris. And I think the good news is that it seems like we have a doomed healthcare system, but I think we can fix it. Tell us a little bit about the instead of this idea of, you know, this idea that we have a doomed healthcare system. Like, what are the three reasons you talk about?

Yeah, so, you know, there are lots of issues that we've already touched upon, you know, conflicts of interest, you know, big pharma doesn't often have the same interest that we do as patients or as practitioners. There's, you know, insurance companies, etc. But, In my book, I argue that there are three issues that are even more fundamental than that. One is that we have not really fully embraced the truth, the reality that this mismatch between our modern diet and lifestyle and what our bodies are hardwired for is what's really driving chronic disease. The second thing is that As I mentioned before, our medical paradigm is not set up to really tackle chronic disease. And the third thing, which we haven't yet talked about, is that the way that we deliver healthcare in the US isn't set up to support the interventions that would have the biggest impact. So let me say a little more about that.

Yeah, yeah.

I haven't touched on that yet. Yeah. So the average visit with a primary care doctor now is between eight and 12 minutes, according to the most recent statistics. Oh, wow. eight and 12 minutes. So if you go into the doctor and you have multiple chronic conditions, which one in four Americans do, and you're taking multiple medications, which many Americans do, and you're presenting with new symptoms, a new problem you haven't even talked to the doctor about, eight to 10 minutes is not going to be enough to barely even say hello, review the medications, and write a prescription for another medication. There's no time to talk about diet, no time to talk about lifestyle, no time to talk about behavior change. And even if those things do get talked about, information is not enough. We know that. If it was, we wouldn't have an obesity epidemic. Everybody knows what they should be eating and doing. For the most part, there's some disagreement about the finer points, but we know that just telling someone to follow a healthy diet or to get more exercise isn't going to be effective. We actually have to create a support infrastructure that actually gives patients the ability to succeed. Let me just use an example. Imagine if you went to the doctor and you had high cholesterol or you had high blood pressure or high blood sugar. They said, okay, well, first of all, imagine that you got that testing before you developed diabetes in the first place or even pre-diabetes. They saw that you were in the high normal range. Instead of just telling you to come back later once you already have pre-diabetes, they say, okay, you're in the normal range, but you're already getting a little up there. We're going to actually intervene now because we know know that if we do that, we can prevent you from developing this in the first place and it'll be a lot more successful. And then they say, we're going to set you up with our health Coach that we have on staff and they're going to come to your house, they're going to do a pantry clean out, they're going to, you know, tell you what foods to eat, they're going to set you up with some recipes and meal plans, they're going to go shopping with you to show you how to actually get this food. Yeah. And then we're going to set you up with a gym membership and a personal trainer and they're going to get you all set, you know, going on this exercise program and great news. your insurance company is paying for all of that.

Not to mention your meditation teacher.

Not to mention your meditation. We can keep going on. And in six months, your blood sugar is going to be normal. But not only that, you're going to have more energy, you're going to sleep better, your digestion is going to be better, you're going to have better relationship with your family and friends, and better you're going to perform at a higher level at work. And that's going to cost less than $10,000 for the healthcare system if they were to do that. and could save well over a million dollars over that patient's lifetime if they had gone on to develop type 2 diabetes. So that's all possible. And it's all afford, not only is it affordable, it's way cheaper than what we're doing now.

That's totally true. I remember this patient came in and their blood sugar was like 115, which is pretty well under pre-diabetes. And I said, wow, did your doctor check that out? He's oh, yeah. I said, well, what did the doctor say? Well, they said we'd watch it. I said, watch for what? They said, Wait until I get diabetes and then put me on medication. I'm like, okay.

It doesn't make any sense at all.

The beautiful thing is using functional medicine to get people on insulin with diabetes and get them off insulin and can reverse the diabetes. Stuff that is just not, I mean, we're doing this here at Cleveland Clinic. We're actually doing a study to actually get people on insulin off insulin and show that we to do it compared to standard care. And nobody believes it because they don't see it. I think we only see what we believe. We don't believe what we see.

That's true. And I would also add that we have become, human beings are very adaptable for better or for worse. And one of the problems is that because chronic disease is so common, we've come to accept that it's just normal. It's not normal. It's not normal at all for humans to develop chronic disease. And that's one of the biggest messages of this book that I hope gets out you don't have to accept it. It's not just getting older. It's not just part of human nature to be chronically ill. And we know this from looking at populations around the world that have maintained their traditional diet and lifestyle and don't have these chronic diseases. They have the same genes, but they don't have these diseases. So we know there's something in our environment. And the good news about that is we can take action and actually and change it and reverse it.

So you're talking about that. How do we change our health and our genes. You know, you talked about, you know, chronic disease, but what are the causes and then how do, what are the cures?

Well, I mean, at the simplest level, you can use a mathematical formula to express it. So modern lifestyle plus genetic predisposition equals modern disease. So, you know, we do, our genes do play a role, but they mostly play a role in terms of determining how the modern lifestyle will screw us up. If you took 100 people who are living a hunter-gather lifestyle and you drop them in New York City, they're not all going to develop the same disease. Some people will get diabetes, some will get hypothyroidism, some will become obese, some will get an autoimmune disease. That's determined by the genes. But the common factor in all of that is they only develop those diseases once they're dropped into that modern environment. They don't develop them and use living their ancestral paradigm. So if they're eating nutrient dense whole foods that don't come in a bag or a box, if they're moving around throughout the day instead of sitting for long periods and they're getting plenty of exercise, they're getting seven to eight hours of sleep a night at least, they're managing their stress, they have social support. They've got confidants and people, they have relationships, they're having pleasure and fun, all the things that are part of our human DNA template. then we're naturally healthy and vital. But when we stray from that, which is very easy to do in our modern lifestyle, unfortunately, that's when we have problems. So it's about realigning again that ancestral template or blueprint, bringing that back online. And the good news is that it's totally possible to do even if you're living in a modern environment. I'm not talking about going back to living in a cave or anything like that.

I have to get a loincloth and a rock.

Asleep in the backyard. No, you live a totally you know, normal life, but you just do it in a way that's more in alignment with what our bodies are set up for.

That's so awesome, Chris. So what are you really excited about in this whole space of medicine? What do you feel is the future of medicine? What do you hope for?

I'm excited about this collaborative model that we've been talking about. I know you've been working on it at the Cleveland Clinic that brings together doctors, licensed practitioners, also mid-level practitioners like nurse practitioners and physician assistants and then, you know, nutritionists and health coaches and to create this super supportive ecosystem for patients where they just feel totally taken care of, supported in every way, not just in terms of medications and, you know, the stuff they get from their doctor, but actually the support and the handholding that they need to be successful with the diet and lifestyle changes. because I think that's been one of the biggest missing elements, even in functional medicine.

For sure.

It's that level of support. You know, we all had an appointment with the doctor where we get a big great treatment plan, but then it falls through the cracks. And so this is the missing element where we create these teams and this team-based approach to care and groups where people can come together and connect with others who are struggling with their same condition and they don't feel so isolated and alone. And that's what really excites me because I think that's possible, not only possible, but it's necessary and it's already happening now at places like Cleveland Clinic.

Yeah, no, it's true. I mean, it was the first thing I said when I got here. I'm like, we need to have everybody go through a group before they even see the doctor. And it took us a while to get that implemented, but now we're doing this and half of the people that go through the group don't even need to see the doctor.

They're already better.

Absolutely. And the ones who don't do get better, but they might need a little tune up or maybe they have metals or some other layer of stuff you have to take care of. And it's pretty awesome. And I think that there was an insight I had after I went to Haiti and saw how Paul Farmer got TB and AIDS better using the power of community. And I think that's really a key feature of functional medicine, which is not only how do we change biology, but how do we change behavior? And that's really what we've been focused on, both of those now. And it's pretty amazing. Well, your book has really kind of created a breakthrough. I think it's created a model for us to really think about healthcare differently. It's starting a conversation that needs to be had. It's really about the future of healthcare. Anybody who's interested in a different way of thinking about disease, a new model for thinking about how to figure it out, and for those practitioners listening, how to get trained in this. I mean, I just check out Chris's book on conventional medicine, his program, the ADAPT program.

Where can they go to learn about this? So the book is unconventionalmedicinebook.com, and they can actually download the first three chapters for free if they'd like to check it out. for buying it. And then all of my training resources are at kresser-institute.com Awesome, Chris.

Well, check out Chris's work. He's a superstar in functional medicine. I encourage everybody to learn about what he's doing and read his blogs because I do.

So, thanks, Chris. Great to have you. Well, thank you, Mark. I appreciate everything you've done for this movement and mentorship and inspiration for me.

As a personally, it means a lot to me.

Thank you, Chris.